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Cardiovascular Lecture 1
Pathophysiology Ch 4 Cardiovascular system
66
Nursing
Undergraduate 3
03/19/2012

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Cards

Term
Excitability
Definition
(irritability) ability of the cells to respond to electrical impulses (stimuli)
Term
Conductivity
Definition
Ability of cardiac muscle fibers/cells to conduct/transmit electrical impulses
Term
Automaticity
Definition
ability to generate an impulse to cntract with no external nerve stimulus (spontaneously and repetitively)
Term
Where is the Cardiovascular Control Center?
Definition
Medulla
Term
Conduction Control: Chronotropic Effect
Definition
rate of electrical conduction
Term
Conduction Control: Dromotropic Effect
Definition
rate of contraction
Term
Conduction Control: Ionotropic Effect
Definition
Strength of Contraction
Term
Electrical Activity: Depolarization
Definition

Increase in Electrical Charge

Accomplished through cellular ion exchange

Generates cardiac contraction

Term
Electrical Activity: Repolarization
Definition
Cellular recovery/ions returning to the cell membrane in preparation for depolarization
Term
Electrical Activity: What does the P wave represent on an EKG?
Definition
atria depolarization
Term
Electrical Activity: What does the QRS complex represent on an EKG?
Definition
ventricular depolarization
Term
Electrical Activity: What does the T wave represent on an EKG?
Definition
ventricular repolarization
Term
What are the three things that affect stroke volume?
Definition

preload

afterload

contractility

Term
Cardiac Output
Definition

volume of blood flowin through either the systemic or pulmonary circuit per minutes (L/min)

normal: 5L/min

Term
Stroke Volume (SV)
Definition
volume of blood ejected per beat during systole, depends on the force of contraction
Term
Preload
Definition

"stretch"

Volume and associated pressure with end diastole in the ventricles (the blood remaining in the ventricle after atrial contraction)

 

Term
Afterload
Definition

"squeeze"

Left ventricular afterload is the resistance or impedance of the ejection of blood from the LV

Term
Blood pressure
Definition
the pressure by the blood against the walls of the vessels
Term
Systolic Blood Pressure
Definition

Top number

cardiac work phase

Term
Diastolic Blood Pressure
Definition

Bottom number

Cardiac Rest phase

Term
Pulse Pressure
Definition

defined as the amount of pressure change to create teh feeling of a pulse

Difference between systolic and diastolic numbers

Term
Blood Vessels: Endothelium (tunica intima)
Definition

inner layer of the blood vessels

Smooth lining of the blood vessel

Term
Blood Vessels :Tunica Media
Definition
Middle Muscular layer of the blood vessel
Term
Unica Adventitia
Definition
Outer elastic Layer (connective tissue that binds vessels to the adjacent structures)
Term
Heart Failure
Definition

inadequate pumping or failure of the cardiact muscle to pump sufficient bloo to meet the body's metabolic needs.

decreased CO, increased Preload, increased Afterload

Term
Compensatory mechanisms activated with Heart Failure
Definition

activation of the SNS

activation of the RAAS

ventricular hypertrophy (restructuring)

Term
Systolic Dysfunction (HF)
Definition
decreased contractility
Term
Diastolic Dysfunction (HF)
Definition
decreased filling
Term
Left-Sided HF
Definition

 

cardiac output falls

blood backs up to the pulmonary circulation

Causes:

  • LV infarction
  • HTN
  • aortic and mitral valve stenosis

Manifestations

  • pulmonary congestion
  • dyspnea
  • activity intolerance
Term
Right-sided HF
Definition

blood backs up to the systemic circulation

causes:

  • COPD
  • left-sided HF
  • pulmonic and tricuspid valve stenosis

manifestations:

  • edema
  • weight gain
Term
Diagnostics for HF
Definition
  • history and physical
  • chest x-ray
  • ABG's
  • Echocardiogram
  • Electrocardiogram
  • BNP
Term
Treatment for HF
Definition
  • identify and manage underlying cause
  • lifestyle modification
  • ACE inhibitors
  • Diuretics
  • Beta-Adrenergic Blockers
  • Calcium channel blockers
  • Biventricular pacemakers
  • intraaortic balloon pump
  • heart transplant
Term
Pericarditis
Definition
Inflammation of the pericardium
Term
Pericardial Effusion
Definition

fluid that accumulates in the pericardial cavity.

Can progress into life-threatening cardaic tamponade

Term
Constrictive pericarditis
Definition

chronic inflammation of the pericardium

the pericardium becomes thick and fibrous from the chronic inflammation and adheres to the heart

The pericardium becomes like a restrictive rubber band that has lost its elasticity

loss of elasticity

restricts cardiac filling --> decreasing CO and causing systemic congestion

Term
Manifestations/Assessment of Pericarditis
Definition
  • Pericardial Friction rub (grating sound heard when breath is held)
  • Sharp, sudden, severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward
  • Dyspnea
  • Tachycardia
  • Edema
  • Fever/flulike symptoms
Term
Diagnostics/Findings of Pericarditis
Definition
  • CBC
  • C-reactive protein
  • EKG (Shows fluid)
  • Chest X-ray (shows large volume)
  • Echocardiogram
  • MRI/CT
  • Cardiac Catheterization
Term
Treatment for Pericarditis
Definition
  • Antibiotics
  • NSAIDS
  • Gluccocorticoid agents
  • Analgesics
  • Pericardiocentesis
  • Pericardectomy (Chronic)
Term
Cardiac Tamponade
Definition

acute cardiac compression caused by excessive fluid accumulation in the pericardium. Complication of pericarditis

affects the pressure gradient of the heart

Life-threatening (may lead to heart failure/shock/death)

Term
Manifestations/Assessment of Cardiac Tamponade
Definition

Paradoxical Pulse (Increase in systolic pressure. abnormal arterial pressure)

muffled heart sounds

narrowing pulse pressure (result of decrease SV and CO)

Term
Diagnostics/Findings of Cardiac Tamponade
Definition

Labs

EKG

chest x-ray

echo

MRI/CT

catheterization

Term
Treatment of Cardiac Tamponade
Definition

pericardiocentesis

pericardectomy

Term
Infective Endocarditis
Definition

inflammatory process involving endothelial layer of the heart (includes valves and septal defects)

Commonly caused by Streptococcus and Staphylococcus infections

Term
Risk factors of Infective Endocarditis
Definition
  • IV drug use
  • Valvular disorders
  • Prosthetic Heart Valves
  • rheumatic heart disease
  • coarctation of the aorta
  • congenital heart defects
  • Marfan syndrome
Term
Manifestations/Assessment of Endocarditis
Definition
  • Fever/chills/Palor
  • s/sx of HF
  • emboli-systemic
  • heart murmur
  • petechiae
  • splinter hemorrhages under the nails, osler's nodes (bumps on palms, tender) & janeway's lesions (Bumps, non tender)
Term
Diagnostics/Findings of Endocarditis
Definition
  • Blood cultures (definitive-- 4-6 sets with 2 positive cultures)
  • Labs: CBC, UA, serum rheumatoid factor, ESR
  • Electrocardiogram-- sees vegetative areas of the heart
  • Echocardiogram and TEE (will show vegetations/abscesses)
Term
Treatment of Endocarditis
Definition
  • IV antibiotics
  • anticoagulants
  • antiarrhymthmics, diuretics, vasodilators, as dictated by complications
  • Surgery
Term
Myocarditis
Definition

Inflammation of the myocardium

an infiltration of myocardial cells by various forms of bacteria/viruses which cause damage and inflammation

organisms, blood cells, toxins, and immune substances invade and damage the muscle

Term
Risk factors for Myocarditis
Definition

rheumatic fever

mono

polio/mumps

typhoid

radiation

lead

medications

chronic use of cocaine

Term
Complications of Myocarditis
Definition

HF

cardiomyopathy

dysrhythmias

thrombus formation

Term
Manifestations/Assessments of Myocarditis
Definition

Flulike symptoms

dyspnea

dysrhythmias

palpitations

tachycardia

heart murmurs

chest discomfort

cardiac enlargement

Term
Treatment for myocarditis
Definition

Antipyretics

Anticoagulants

Antidysrhythmics

Immuno suppressive agents

Term
Stenosis (valvular disorder)
Definition

narrowing (obstructed flow)

less blood can flow through the valve

causes decreased cardiac output, increased cardiac workload and hyptertrophy

Term
Regurgitation (valvular disorder)
Definition

insufficient closure

blood flows in both directions through the valve

causes decreased cardiac output, increased cardiac workload, hypertrophy, and dilation

Term
Cardiomyopathy
Definition

conditions that weaken and enlarge the myocardium

Dilated, Hypertrophic, and Restrictive Cardiomyopathy

Term
Dilated Cardiomyopathy
Definition
  • Characterized by gross dilation of all 4 chambers of the heart, interference with systolic function (impaired systolic function) and damage to myofibrils
  • Risk is higher with aging and African American Men
  • most common type
  • Cardiomegaly and ventricular dilation damages myocardium muscle fibers, resulting in decreased cardiac output and blood stagnation
Term
Causes of Dilated Cardiomyopathy
Definition
  • chemotherapy
  • alcoholism
  • cocaine abuse
  • pregnancy
  • infections
  • thryotoxicosis
  • DM
  • neuromuscular diseases
  • HTN
  • CAD
  • hypersensitivity to medications
  • ischemia
Term
Manifestations/Assessment of Dilated Cardiomyopathy
Definition

S/Sx of HF

dyspnea & fatigue

nonproductive cough

orthopnea and PND

dysrhythmias/angina

tachycardia/murmurs

cool, pale extremities/poor cap refill

ascites, hepatomegaly & jugular vein distension

Term
Treatment dilated cardiomyopathy
Definition
  • angiotensin converting enzyme inhibitor & diuretics
  • digoxin & beta adrenergic blockers
  • antidysrhythmics
  • implantable cardiac defibrillator cardioversion
  • pacemaker/valvular repair & heart transplant
Term
Hypertrophic Cardiomyopathy
Definition
myocardial disease characterized by a distinctive pattern of hypertrophy-- a disproportionate thickening of the interventricular septum when compared to the free wall.
Term
Treatment for Hypertrophic Cardiomyopathy
Definition

beta-adrenergic blockers

calcium channel blockers

surgical removal of excess myocardium

Considerations: Strenuous activity is prohibited

Term
Restrictive Cardiomyopathy
Definition

Abnormal diastolic filling occurs as a result of infiltration of the endocardium or myocardium with fibro-elastic tissue

common in South and Central America, India, Asia, and Africa

Term
Causes of Restrictive Cardiomyopathy
Definition

Amyloidosis

hemochromatosis

radiation exposure to the chest

connective tissue diseases

myocardial infarction

sarcoidosis

cardiac neoplasms

Term
Manifestations/Assessment of Restrictive Cardiomyopathy
Definition

many cases are asymptomatic

when present, symptoms include:

fatigue/dyspnea/orthopnea

weakness/activity intolerance

angina/murmurs

hepatomegaly/jugular vein distention/ascites

peripheral cyanosis & pallor

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